References
Rhabdomyolysis and elderly fallers
Abstract
Elderly people who have fallen make up a large proportion of the ambulance workload: falls and fall-related injuries are prevalent within the older population, with half of those aged >80 years falling annually. Rhabdomyolysis is a common and potentially life-threatening condition, which has many causes. It occurs when the contents of skeletal muscle are released into the bloodstream and cause an obstructive cast in the glomerulus, leading to acute tubular necrosis and acute kidney injury. Of the multiple causes of rhabdomyolysis, significant ones are statin use and falls where elderly people are immobile for prolonged periods of time. However, a large number of patients are discharged by ambulance crews following long-lie falls, and they are more likely to request ambulance reattendance in the following month and have increased mortality rates following discharge from ambulance crews. Rhabdomyolysis often occurs after the initial fall, so emphasis should be placed on recognising not only the condition but also those at increased risk of developing it.
Falls and fall-related injuries are an all too common occurrences in the prehospital environment and are especially prevalent within the older population. The National Institute for Health and Care Excellence (NICE) (2013) estimates that 30% of those aged >65 years and half of those aged >80 years experience at least one fall per year. NICE also states that falls cost the NHS more than £2.3 billion annually and greatly affect the mortality of those who experience them.
The article aims to reiterate and extend on an overview of rhabdomyolysis for prehospital clinicians written by Nellist and Lethbridge (2013), with an greater focus on falls in elderly people, given that this is a life-threatening but lesser-known complication of falls in this population (Criner et al, 2002).
This paper will then examine the underlying pathophysiology of rhabdomyolysis and the risk factors that may increase the likelihood of it developing in older people who have fallen. Suggestions will be made regarding identifying the potential for its development and therefore facilitating its early recognition and treatment to reduce harm caused. Recommendations are made to increase awareness and recognition of the condition.
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